Ten-year outcomes of corneal cross-linking: A Save Sight Keratoconus Registry study

Abstract

Purpose : To report long-term (10-year) outcomes of corneal cross-linking (CXL) in eyes with keratoconus.

Methods : Data from routine clinical practice was captured through the Save Sight Keratoconus Registry, an international database of patients with keratoconus. Patients with no prior intervention who had undergone epithelium-off CXL were included. The CXL was performed with Avedro KXL (n=25, 51.0%) or INNOCROSS UV-X (n=24, 49%). Outcomes included visual acuity (VA) measured with the patient’s habitual visual correction method, Kmax (93.9% cases measured with Oculus Pentacam), K2, minimum corneal thickness (MCT), and the frequency of adverse events. Paired t-test was used to compare the outcomes at baseline and follow-up visits.

Results : Data from 8 practices in Australia, Italy and Spain[HK1] [SW2] [SW3] were included. 49 eyes of 33 patients (mean ± SD age at baseline 32.6 ±11.1 years; 49% female; 96.7% White or Caucasian) with keratoconus were included. The differences in outcomes between baseline (mean visual acuity [95% confidence interval] 71.8 [66.8 to 76.8] logMAR letters; Kmax 52.6 [50.3 to 54.9] D; K2 47.4 (46.0 to 48.7) D; MCT 478 (462.6 to 493.3) µm) and follow-up at 10 years after CXL were not statistically significant (visual acuity (70 (64.5 to 75.6) logMAR letters; Kmax 53.8 (51.3 to 56.4) D; K2 47.7 (46.1 to 49.3) D; MCT 472.3 (450.8 to 493.9) µm; all p >0.05). At the follow-up visit, no adverse events (clinically significant haze, scarring, persistent epithelial defect, recurrent erosion, progressive keratoconus, stromal oedema, microbial keratitis, herpes simplex virus keratitis, varicella zoster virus keratitis, and sterile infiltrate were recorded.

Conclusions : Our long-term real-world data across multiple sites supports CXL as an effective treatment for stabilising keratoconus. CXL was safe, without any adverse events, particularly at 10 years.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.